Sunday, November 12, 2017

Prophylactic Bilateral Mastectomy with Immediate Reconstruction


I remember telling Brandon when we were newly married not to get too attached while motioning to my chest area, in one of those kidding-not-kidding conversations. And, while we've been able to laugh that off for the past eleven years, that statement has turned to truth, and I will be having a prophylactic bilateral mastectomy on the 28th of this month. Just three weeks away. 

To be clear, I do not have breast cancer

A prophylactic bilateral (double) mastectomy is preventative surgery to remove all of the breast tissue with the ultimate goal of reducing the risk of developing breast cancer up to 97-100%. 


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B A C K S T O R Y

It was the summer of my sophomore year of college when my mom was diagnosed with breast cancer, fifteen years ago now. I was away at school in Lexington for the duration of her treatment, which included several nasty rounds of chemo, followed by weeks of radiation. She lost her hair, was sick as a dog, but fought through it like the champ she is and has been cancer-free since. Her mom, my Grammy, had breast cancer at sixty, many years before mom, along with my maternal great-grandmother and great-aunt. My mom's three sisters - my aunts - have also all had breast cancer in the past fifteen years. All currently remain in remission. 

My mom and dad with their grandchildren.
So, clearly, there is a very very very strong history of breast cancer on my mom's side.

My OBGYNs have encouraged me at my annual appointments- probably for the past five years - to do genetic counseling, and after dragging my feet, I finally met with a genetic counselor at our local hospital in April of this year. During genetic counseling, you basically meet with a nurse who has been certified to discuss your family tree along with the instances of cancer to help you determine whether or not you're a good candidate for genetic testing. 

I brought along the genetic testing results from my mom and her sister to share with the counselor and together we reviewed all of the cases of cancer, the age of diagnosis, and the outcome of each. While those tested - including my mom - do not carry BRACA1 or 2 (most well-know 'breast cancer genes' whose carriers have upwards of a 50% chance of developing cancer), one of my aunts was positive for a mutation of the NBN gene. This gene is responsible for the production of nibrin, whose job is to repair damaged DNA. In simple terms, it is a tumor suppressor.  In terms of genes associated with breast cancer, it is a newly researched one, and its carriers have an elevated risk of breast cancer compared with the normal population, though that risk level is currently unknown. 

Because my mom's testing is 15-years-old at this point, the next step was to have her re-tested to see if she, too, was positive for a mutation of the NBN gene (which wasn't a marker at the time of her testing). She was, not surprisingly, and I submitted a blood sample to a genetic testing lab shortly after finding out her results. 
Getting my mammogram in July 2017.
My results were phoned to me about two weeks later to confirm that I, too, carry the mutation of the NBN gene. By itself, it's difficult to determine just how detrimental it is to carry the NBN gene, but combined with my family history, it is concerning and I was recommended to a surgical oncologist to discuss my next steps. 

While surgery wasn't the only option I was presented, my doctor said it was a reasonable measure considering my genetic predisposition and family history, and I really went into the appointment knowing it was what I would choose. The youngest cancer case in our family was 36, and I'll be 35 next month.

Ultimately, the bottom line for me is this: Brandon, Beckham, Faith, and Benny.  


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S U R G E R Y 

I met with an absolute ass of a plastic surgeon in August, who barely looked up from his clipboard long enough to notice the tears streaming down my face.  He used fancy doctorese to describe the procedure that was ultimately going to reconstruct my breasts, and despite fully understanding what I was in for, the reality of losing a part of me was just overwhelming in that moment.  The long-term implications of the surgery are more than just the shape I'll have afterward and I felt like he neglected to acknowledge the psychological impact. While I don't doubt his medical prowess, his personal preferences as a surgeon and apathetic posture towards my personal outcomes of the procedure weren't ideal for such a life-changing surgery. 

When he finally noticed I was having a hard time keeping together, he responded with, "Obviously you weren't very prepared for this appointment," in an offhanded and extremely insensitive way. I WISH I would've been quick enough to say, "Would anything prepare you to have you balls chopped off, doctor?" #hindsight  Needless to say, he is not the plastic surgeon I chose. Bye, Felicia.

Instead, I found a female doctor whose ideals for surgery aligned with my desired outcomes.

Anyway. 

The surgery is scheduled to take approximately four hours, as I'm opting for immediate reconstruction. This means, I will not have tissue expanders put in and will, instead, have silicone gel implants inserted immediately following the mastectomy.  This will allow me to have a single surgery. Not every woman or doctor is a fan of this technique for a variety of reasons, but my build and my desire to simply replace what I already have (read: I'm not getting bigger b(o)(o)bs), made me a good candidate.  Both my surgical oncologist and plastic surgeon will be present for the surgery and are on board with what I want. I will be required to stay at the hospital for 1-2 nights post-surgery.

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R E C O V E R Y

I'm planning for the worst and hoping for the best! I cannot lift greater than ten pounds for the first six weeks after surgery, which means I cannot pick up my babies :(  Sad. No working out for six weeks, either.  I also won't be cleared to drive or cook for awhile, wash my hair, or do anything that requires moving my arms above my shoulders. Fortunately, Brandon is taking off for almost a week to take care of me and our families live close by to help out with the kiddos.  I will have 2-4 drains to help with fluid and swelling, and it sounds like I'll be sleeping upright in our recliner for a month. Apparently, I'm going to live in button-downs and mastectomy tanks.  Everyone's recovery is different, so I guess we shall see.

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T H E  N E X T  T H R E E  W E E K S

I had my physical this past week and am all cleared for surgery and will still meet with my plastic surgeon the day before the procedure. With the holidays approaching, I'm planning to get as much shopping done as I possibly can and decorate minimally so take-down isn't extensive. With our kitchen remodel in full-swing and set to finish the week before my surgery, I'll be cutting it close with getting the house presentable again and decorated (we're currently living among all the new cabinetry in our family room).  If we get a tree up,  a wreath on the front door, and stockings hung on the fireplace, we're going to call it a win.  Actually, being stuck in a recliner watching Christmas movies by the fire doesn't sound like the worst way to recover, now that I think about it ;)

To my teacher friends: I'm anticipating taking the month of December off to recover, so I will be minimally involved on Teachers Pay Teachers.  I still plan to check in with Q and As and maintain my social media pages as I can. 

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H O W  D O  I  F E E L?

I'm going to be totally honest here: I'm terrified. I've intentionally emotionally distanced myself from it for the past several months knowing how big and scary my feelings about it actually are.  But now that I'm in the final countdown, I'm so scared. Surgery and anesthesia and being under for four hours completely terrifies me. I'm so afraid I won't wake up and all I can think about is my children growing up without a mommy and Brandon losing his wife. The thought is just unbearable and I sit here crying now as I type this. 

Outside of the actual surgery, the recovery is daunting, I'm sad to lose feeling in my chest forever, I'm stressed about Brandon and the kiddos having to do life without me for a bit, and anxious about losing control over the daily goings-on while I recover (i.e. making lunches, school pick-up and drop-off, helping with homework, grocery shopping, laundry, picking up the house, etc). 

While this is obviously an elective surgery, it's also a catch-22...sit around and wait for cancer and hope that it doesn't come? Or, pray that should I get cancer that I'm a survivor like my mom? Or, praise God for the fortunate option that modern medicine has allowed me know my risk and do something about it? No good answer, but for me, this seemed like the best choice. 

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P L E A S E  P R A Y

...for a successful, uncomplicated surgery.

...wisdom, guidance, and careful hands for the doctors and nurses.

...a sense of peace for myself and our family.

...good health and strong immune systems for myself and our family.

...for Brandon, Beckham, Faith, and Benny.

...no infections and complete healing post-surgery.

...a cancer-free pathology report. (no reason to believe this would be an issue, but they do a pathology report on the tissue removed nonetheless)

T H A N K  Y O U !

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